BEIRUT: In a country where plastic surgery and other cosmetic procedures are the norm, a number of unofficial “clinics” have emerged in which unlicensed practitioners are providing services like Botox injections, liposuction and hair implants.

These “mini-markets,” as one influential plastic surgeon has labeled them, are providing medical procedures that could end up seriously harming patients.

“Even minor injections may give reactions that lead to cardiac arrest,” said Dr. Georges Ghanime, the president of the Lebanese Society of Plastic Reconstructive and Aesthetic Surgery, from his office at Geitawi Hospital.

“You have to have at least the basics to perform resuscitations.”

In response to the phenomenon, the Cabinet and the Health Ministry have recently put forward a draft law to be voted on by Parliament that addresses the issue.

The head of Parliament’s Committee of Public Health, Future MP Atef Majdalani, said: “There is a need to draw a line between the regular beauty parlors, which basically deal with hairdressing and manicures, and beauty centers that carry out hair implants and beautification with Botox.”

“There are many cases in which serious damage was done to the patients, including burns, or even loss of sight. It is [both] necessary and a duty that we regulate the practice, notably by identifying responsibilities and holding the people accountable by law,” Majdalani added.

Ghanime said that the LSPRAS initially contacted the Health Ministry 10 years ago but were told that the issue fell under the jurisdiction of the Economy Ministry because beauty parlors and similar shops are businesses and not medical centers.

Doctors interviewed by The Daily Star said currently anyone with a doctorate in a medical field, including dentists, could legally perform procedures such as Botox injections and hair implants. But the Parliament committee and doctors admit similar procedures are being performed in beauty salons and other unofficial clinics by beauticians and other figures that are unqualified.

“The law is aiming to have stricter regulation so that only certified plastic surgeons and dermatologists can perform such procedures,” Ghanime said.

“What is being done now is a very good thing because we are working toward regulation on how to deal with these procedures,” he added.

“[The draft law] talks about everything from lasers for hair removal to Botox, liposuction, and any bull ?t talking about external or internal facelift.”

“Regulation is a good thing,” agreed Dr. Antoine Abi Abboud, a plastic, reconstructive, and aesthetic surgeon. “Probably even in the U.S. and Europe they have similar problems but more regulation.”

Abi Abboud added that many general practitioners who are authorized to perform such procedures but have little specific training or knowledge about them will often agree to do them for extra money.

The draft law states that only properly licensed plastic surgeons or dermatologists can perform such procedures and that any clinic that does not abide by the law will be shut down.

Mohammad Deeqa, a salon owner in Ras al-Nabaa in Beirut, said his salon did not offer the service first hand. “I am only a middleman,” he said. “If a woman comes to me and says she wants Botox, I refer her to a doctor.”

If the draft law is passed, Ghanime said, boutiques or other clinics providing unlicensed procedures will have three months to shut down. Clinics will be required to have 100 square meters of surface to perform operations, “not 20 square meters like any [cosmetologist] doing nails and things like this,” he added.

Ghanime told The Daily Star that a vast improvement in plastic surgery in Lebanon was behind the push for this law.

“Plastic surgery and cosmetic surgery and medicine are now depended on all over the world so Lebanon has to be up to date and on the highest safety level,” he said. “Plastic surgery has to be done by plastic surgeons and qualified members of the Lebanese society of plastic surgery.”

But the draft law will surely face some kickback from other practitioners who, despite not being a member of the LSPRAS, feel they are qualified to perform profitable procedures like Botox.

Dr. Hayssam Tohme, a gynecologist and a member of the American Academy of Cosmetic Surgery who performs Botox and similar procedures, agrees the profession “needs to be regulated,” but argues such procedures should not be limited to only plastic surgeons.

Tohme argued that other doctors may have proper accreditation from abroad to perform Botox and similar treatments and pointed out that medical professionals in Europe and the United States who are not plastic surgeons are still allowed to work in the field.

Using himself as an example, he said that he was properly trained to administer plastic surgery despite being a gynecologist and not being part of the LSPRAS.

Tohme recognized, however, that these procedures were often being performed by unlicensed professionals. “Even a certified nurse doesn’t have the right,” he said.

For Ghanime, the bottom line is simple: Only plastic surgeons should be able to conduct plastic surgery in Lebanon.

“[The law here is] stricter but also [in the U.S. or Europe] if they are having any problems [with the procedures] they go to jail and pay millions of dollars,” he said, whereas in Lebanon “an [cosmetologist] doing nails” will not see such a harsh sentence for a botched procedure.

“What we have to say is that plastic surgery has to be done by plastic surgeons and qualified members of the Lebanese society of plastic surgery and we did this to put people and patients on the safe side,” he said. “Especially since patients are paying the same fees for plastic surgery with a surgeon or at any “mini-market.” – Additional reporting by Ghinwa Obeid

A version of this article appeared in the print edition of The Daily Star on August 26, 2014, on page 4.

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In a country where plastic surgery and other cosmetic procedures are the norm, a number of unofficial "clinics" have emerged in which unlicensed practitioners are providing services like Botox injections, liposuction and hair implants.

The draft law states that only properly licensed plastic surgeons or dermatologists can perform such procedures and that any clinic that does not abide by the law will be shut down.

If the draft law is passed, Ghanime said, boutiques or other clinics providing unlicensed procedures will have three months to shut down.

Ghanime told The Daily Star that a vast improvement in plastic surgery in Lebanon was behind the push for this law.

Tohme argued that other doctors may have proper accreditation from abroad to perform Botox and similar treatments and pointed out that medical professionals in Europe and the United States who are not plastic surgeons are still allowed to work in the field.

Using himself as an example, he said that he was properly trained to administer plastic surgery despite being a gynecologist and not being part of the LSPRAS.

Tohme recognized, however, that these procedures were often being performed by unlicensed professionals.

For Ghanime, the bottom line is simple: Only plastic surgeons should be able to conduct plastic surgery in Lebanon.